General News from the Health Decision Making SIG
We are looking forward to the 35th annual SBM meeting, April 23-26th, in Philadelphia, and have several SIG sponsored events planned. First, our Health Decision Making SIG breakfast meeting will be held Thursday April 24th from 7:30 am to 8:30 am. Attending will be a great way to hear about Health Decision Making programming for this meeting, will provide an opportunity to exchange ideas about new SIG activities going forward, and allow for some relaxed time to network with other colleagues in the field. Second, in conjunction with the Cancer SIG, the Health Decision Making SIG will be co-sponsoring a midday meeting which will be held Thursday April 24th at 11:40 am, entitled, "Education and Decision Aids to Advance Health: A Showcase of the Latest Software." This event is planned as a forum to exchange ideas and foster potential collaborations among researchers interested in electronic educational and decision aids. Finally, the Health Decision Making SIG is sponsoring three interesting symposium submissions. The first addresses challenges and opportunities associated with using health decision making theories in behavior change interventions. The second submission addresses decision making and genomic technologies. The final symposium submission addresses social, affective, and cognitive neuroscience in health decision making. We are hopeful that one or more of the symposiums will be accepted. See you in Philadelphia!
Hot Topics in Health Decision Making
Financial Incentives in Behavioral Medicine: A Complex Issue
Arlen C. Moller, PhD, Health Decision Making SIG Outlook Liaison
Erika A. Waters, PhD, MPH, Health Decision Making SIG Co-Chair
Jennifer L. Hay, PhD, Health Decision Making SIG Chair
Researchers and practitioners interested in Health Decision Making may also be interested in how financial incentives are being used to promote healthier choices. Financial incentives are increasingly used as components of health behavior interventions, yet the long-term efficacy of interventions that rely heavily on this tool is actively debated.
One context for growth in popularity of financial incentives has been within employer or insurer sponsored wellness programs. Several surveys of large U.S. employers have documented a trend toward more frequent use of incentives within such programs, as well as increases in the median cash value of those incentives. Provisions within the U.S. Patient Protection and Affordable Care Act (PPACA) are designed to encourage employers and insurers to link incentives to healthier choices (Pear, 2013). This provides a clear opportunity for Health Decision Making SIG members to work with organizations to design and implement evidence-based programs.
Another important context is in the recent proliferation of web and smartphone apps designed to promote healthy behavior using financial incentives as the primary change promoting tool (e.g., StickK, Gympact, Earndit). Collectively, these apps have attracted millions of users (and revenue). Health Decision Making SIG members could contribute to improving many of these incentive-based mHealth interventions.
Further, financial incentives are applied to an extremely wide range of health behaviors, perhaps wider than any other strategy or technique used in behavioral medicine (e.g., self-monitoring, social support, motivational interviewing, etc.); this includes payments for participation and for performance, and in contexts that include alcohol and drug abuse treatment, drug adherence, behavioral adherence, diet, physical activity, weight loss, smoking cessation, vaccination, annual screening completion, and even the promotion of the use of birth control or sexual abstinence. Health Decision Making SIG members are uniquely well suited to working across different health behavior silos.
Unquestionably, payments can be a powerful tool with wide reaching appeal; and researchers from the SBM community have made significant contributions to a growing literature evaluating the efficacy of interventions that feature payments (Hanoch & Finkelstein, 2013; Lussier, Heil, Mongeon, Badger, & Higgins, 2006; Lynagh, Sanson-Fisher, & Bonevski, 2013; Volpp, Pauly, Loewenstein, & Bangsberg, 2009). However, surprisingly few studies have demonstrated that interventions featuring financial incentives as their centerpiece produce sustainable, long-term change after the payments have ended. Achieving sustainable results has proven especially challenging when incentives are used to promote changes in lifestyle, such as for improving diet, increasing physical activity, or promoting weight loss (Burns, Donovan, Ackermann, Finch, Rothman, & Jeffery, 2012; Paul-Ebhohimhen & Avenell, 2007). Some authors have raised concerns that financial incentives may be experienced as subtly or even overtly coercive - problematic in itself, and a dynamic that may also disrupt internalization of motivation and habit formation, thereby contributing to problems with sustainability (Moller, Buscemi, McFadden, Hedeker, & Spring, 2013; Moller & Deci, in press; Moller, McFadden, Hedeker, & Spring, 2012). For example, a program using financial incentives to encourage participation in a health risk assessment at Penn State was recently met with significant resistance from faculty and staff who considered the incentives coercive (Singer, 2013). Others have expressed concerns over the potential for payments to produce unintended consequences, like cheating, deception, or taking unhealthy shortcuts.
Are financial incentives in behavioral medicine a panacea or coercive scourge? It should be clear from the discussion above that the issue is much more complex than broad stroke indictments or endorsements can convey. Given the rising popularity of using payments in behavioral medicine in countless different ways, a much more nuanced understanding of these issues is required. To this end, we think members of the Health Decision Making SIG are well positioned to take a lead role in fleshing out these nuances in our research, implementing them in practice, and communicating them more effectively to others who may be designing incentive-based interventions without attending to evidence-based practice. Toward exploring these and related issues in greater depth, this year's SBM conference in Philadelphia will include an exciting Opening Keynote Debate featuring Dr. Kevin Volpp and Dr. Pedro Teixeiria. Dr. Ken Resnicow will moderate the debate, titled "Promoting Health Behavior Change: Behavioral Economics Meets Self-Determination," to be held on Thursday April 24th 2014 from 10:30am to 11:30am. We hope that many of you with interests in health decision making will attend!
Burns, R. J., Donovan, A. S., Ackermann, R. T., Finch, E. A., Rothman, A. J., & Jeffery, R. W. (2012). A theoretically grounded systematic review of material incentives for weight loss: Implications for interventions. Annals of Behavioral Medicine, 44, 375-388.
Hanoch, Y., & Finkelstein, E. A. Health psychology meets behavioral economics: Introduction to special issue. Health Psychology, 32, 929-931.
Lynagh, M. C., Sanson-Fisher, R. W., & Bonevski, B. (2013). What's good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change. International Journal of Behavioral Medicine, 20, 114-120.
Lussier, J. P., Heil, S. H., Mongeon, J. A., Badger, G. J., & Higgins, S. T. (2006). A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction, 101, 192-203.
Moller, A. C., Buscemi, J., McFadden, H. G., Hedeker, D., & Spring, B. (2013). Financial motivation undermines potential enjoyment in an intensive diet and activity intervention. Journal of Behavioral Medicine. Retrieved from http://link.springer.com/article/10.1007/s10865-013-9542-5
Moller, A. C., & Deci, E. L. (in press). Psychology of getting paid: An integrated perspective. In E. Bijleveld & H. Aarts (Eds.), The psychological science of money. Springer.
Moller, A.C., McFadden, H. G., Hedeker, D., Spring, B. (2012). Financial motivation undermines maintenance in an intensive diet and activity intervention. Journal of Obesity, 1-8.
Pear, R. (May, 2013). Employers get leeway on health incentives. The New York Times. Retrieved from http://www.nytimes.com/2013/05/30/business/new-rules-give-employers-leeway-on-use-of-health-incentives.html
Paul-Ebhohimhen, V., & Avenell, A. (2007). Systematic review of the use of financial incentives in treatments of obesity and overweight. Obesity Reviews, 9, 355-367.
Singer, N. (September, 2013). On campus, a faculty uprising over personal data. The New York Times, Retrieved from http://www.nytimes.com/2013/09/15/business/on-campus-a-faculty-uprising-over-personal-data.html?smid=pl-share
Volpp, K. G., Pauly, M. V., Loewenstein, G., & Bangsberg, D. (2009). P4P4P: An agenda for research on pay for performance for patients. Health Affairs, 28, 206-214.